Loading...Loading...Policy No: 136
Originally Created: 01/01/2019
Section: Administrative
Last Reviewed: 11/01/2023
Last Revised: 11/01/2024
Approved: 10/10/2024
Effective: 06/01/2024
Policy Applies To: Medicare Advantage
This policy applies only to physicians, facilities and other qualified health care professionals.
Palliative Care
Specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Regence considers palliative care appropriate for a wide variety of diagnoses, chronic pain alone does not qualify a member for palliative care.
Palliative care services are specialized medical care for people living with serious illness who may have more focused medical goals depending on their prognosis. Care is focused on providing patients with relief from symptoms, pain and stress of a serious illness regardless of the prognosis. The individual providers that can provide palliative care can include but are not limited to:
- Physician
- APRNs - Includes Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs), depending on state regulations on scope of practice
- Physician Assistant/Physician Associate
Social Worker
Acceptable Current Procedural Terminology (CPT®)/Healthcare Common Procedure Coding System (HCPCS)/Rev Codes for facilities
- 90832-90834 and 90837-90840 - Clinical Social Worker Visits. Individual psychotherapy insight oriented.
- 90845-90847 – Psychoanalysis and Family Therapy
- 98960-98962 – Education and Training for patient self-management
- 99071 – Medicine Service
- 99078 – Physician educational services rendered in a group setting
- 99324-99328 and 99334-99337 - Domiciliary or Home visit for counseling
- 99341-99345 and 99347-99350 - Home Visits (Physician/Nurse Practitioner).
- 99354-99355 – Prolonged Psychotherapy Services
Claim line should also be billed with Z51.5 as the primary ICD-10 code
99497 and 99498 can still be billed as palliative care, regardless of ICD-10, and will be subject to general medical benefits.
Centers for Medicare & Medicaid Services (CMS), 2016. ‘Incident To' Services. MLN Matters Number: SE0441
Centers for Medicare & Medicaid Services (CMS), 2017. Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services. Section 60.4 – Services Incident to a Physician's Service to Homebound Patients Under General Physician Supervision
Noridian Healthcare Solutions, 2022. 'Incident To' Services
Claims and Payment; Claims Submission
Center to Advanced Palliative Care - CAPC
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